Feature | October 30, 2008| Nick Obradovich

Noninvasive Angiography Outlook for 2009

As data accumulates, CTA inches toward gold standard for multiple patient populations.

Toshibas Aquilion 64-slice was used in the Core 64 trial, which showed that coronary CTA was accurate in detecting blockages of greater than 50 percent, with a sensitivity of 85 percent and a specificity of 90 percent.

Going into 2009, proponents of coronary CT angiography (CTA) are confident that the scan’s ever-increasing acceptance will lead to it becoming the gold standard in imaging for patients with low or intermediate risk of coronary artery disease. From a business perspective, the CTA remains a driving force in the cardiac CT market.

While coronary MR angiography (MRA) has seen an improvement in image quality, according to clinicians, the scan is not as accepted or used as much as CTA due to image quality.

Inside the Numbers

CTA scans have increased substantially in the past five years, according to many clinicians. In March 2008, IMV Medical Information Division Inc., a market research firm specializing in medical imaging, released a study confirming the data.
According to IMV’s report, there were approximately 4.7 million CTA scans performed in 2007, increasing from 2.2 million scans in 2003. The report found that among sites with CT scanners, 66 percent performed CTA scans in 2007. In 2003, under half (44 percent) of sites with CT scanners performed CTA.

According to a June IMV report, there were approximately 2.5 million MRA scans. Taking the total number of CTA and MRA scans for 2007 (7.2 million), nearly two-thirds were CTA, underscoring the fact that CTA has leaped ahead of MRA.

CTA appears to enjoy the advantage over MRA when imaging the coronary arteries, primarily due to superior spatial resolution. Some clinicians believe that an coronary MRA can be read as effectively as a CTA scan if the cardiologist or radiologist has experience reading both scans.

Core 64 Results

Not all cardiologists believe CTA should be the gold standard for finding and accessing blocked arteries, but last year’s results of the Coronary Artery Evaluation Using 64-Row Multidetector Computed Tomography Angiography trial (CORE-64) trial leant statistical credibility to the scan. The CORE-64 trial — funded by Toshiba America Medical Systems — was conducted by researchers from nine centers in seven countries. The trial studied 291 patients who were scheduled to undergo invasive coronary angiography for suspected or unknown coronary artery disease.

Using Toshiba’s Aquilion 64 CT scanner, the trial found that CTA was accurate in detecting blockages of greater than 50 percent, with a sensitivity of 85 percent and a specificity of 90 percent.

“I was always thought that, even with the 16-row Aquilion we had, MDCTA for the coronary arteries was ready for prime time,” said Melvin E. Clouse, M.D., radiologist at Beth Israel Deaconess Medical Center, professor and vice chairman emeritus, department of radiology, Harvard Medical School. “The first image I ever took with it was one of the best I had ever done. Even if you believed [that 64-slice CTA was an effective scan], I think Core 64 proved it.”

Many clinicians feel the urgency of developing a cardiac test that can better determine who is valuable to having a heart attack.

“For about 200,000 people every year, a fatal heart attack is their first, last and only symptom,” Dr. Clouse said. “So what you want to do is get a simple test.”

Going into 2009, clinicians are optimistic about CTA’s future, in large part to due technological innovations. Siemens’ SOMATOM Definition with dual-source technology has improved temporal resolution and helps better characterize plaque, according to several clinicians who have spoken to Diagnostic & Invasive Cardiology this year. Toshiba’s Aquilion One 320-slice required less contrast, reducing the dose to levels near what would be used in a cath lab, according to clinicians.

“Our goal should be to reduce the number of imaging methods for the heart, if that can be done,” Dr. Clouse said. “MDCT is much more rapid, less complicated, and eventually, I think, we’ll get to perfusion imaging. We’ll be competing actively with MRI. But, we have to do it without so much radiation. We should target our studies where we get our dose rates down to 3 and 5 milliseverts for an angio study.”

Related Content

Medic Vision, SafeCT-29, XR-29 compliance, CT systems, RSNA 2015

Image courtesy of Siemens

Technology | Computed Tomography (CT)| November 24, 2015
Medic Vision Imaging Solutions Ltd. announced the introduction of SafeCT-29. Designed to be computed tomography (CT)-...
Hitachi Medical Systems America, HMSA, Evolution 5, MRI software platform, Echelon Oval, RSNA 2015

Echelon Oval image courtesy of Hitachi Medical Systems America Inc.

Technology | Magnetic Resonance Imaging (MRI)| November 24, 2015
In conjunction with the upcoming Radiological Society of North America (RSNA) 2015 exhibition, Hitachi Medical Systems...
CIRS, Dynamic Cardiac Phantom, CT, RSNA 2015

Image courtesy of CIRS Inc.

Technology | Quality Assurance (QA)| November 24, 2015
The Dynamic Cardiac Phantom is a precision instrument which mimics the translation and rotational motion of the heart...
3-D modeling, reconstructed hearts, child heart transplants, AHA Scientific Sessions 2015
News | Advanced Visualization| November 23, 2015
A new 3-D computer modeling system may significantly improve a surgeon’s ability to select the best-sized donor heart...
Fraunhofer MEVIS, MRI, CaFuR, real-time MRI, beating heart

The software developed by Fraunhofer MEVIS automatically identifies the breathing and heart contraction phases in the data independent of the ECG information. This allows for a fast and easy examination of heart patients. Image courtesy of Fraunhofer MEVIS.

News | Magnetic Resonance Imaging (MRI)| November 18, 2015
Today, magnetic resonance imaging (MRI) allows more gentle, precise and cost-effective heart disease diagnosis. However...
Feature | Remote Viewing Systems| November 18, 2015 | Kim Garriott
There is a growing need to exchange and share imaging studies with outside entities.
Kopp Development, FerrAlert FILM, Ferrogmagnetic Incident Log Manager, Joint Commission standards

The FerrAlert Ferromagnetic Incident Log Manager (FILM) device is designed to work exclusively with Kopp Development's FerrAlert Halo II Plus MRI entryway system, pictured above. Image courtesy of Kopp Development Inc.

Technology | Magnetic Resonance Imaging (MRI)| November 17, 2015
Kopp Development Inc. announced the release of the new accessory for their latest magnetic resonance imaging (MRI)...
GE Healthcare, MRI, RSNA 2015, Signa Explorer, Signa Creator, Signa Pioneer

Signa Explorer image courtesy of GE Healthcare

News | Magnetic Resonance Imaging (MRI)| November 16, 2015
At this year’s Radiological Society of North America (RSNA) annual meeting, GE Healthcare is showcasing continued...

Cardiologists using the Philips spectral CT software to view a spectral CT image reconstruction at various energy levels.

Feature | CT Angiography (CTA)| November 12, 2015 | Dave Fornell
Computed tomography has seen rapid growth in all segments of medicine over the past two decades, and recent advances
Sponsored Content | Videos | TCT| November 05, 2015
DAIC Editor Dave Fornell offers his choices for the most innovative new interventional cardiovascular technologies pr
Overlay Init